直到民主党在马萨诸塞选举中遭遇惨败之前，奥巴马在医改上似乎一直稳操胜券。他在牌桌上摊了太多政治筹码以至于很难退出游戏，因而，在周四电视直播的医疗改革峰会召开之前，他把所有的筹码都押上了。
奥巴马昨日宣布了一项医改方案，以掌握主动――一位发言人称之为达成协议的"开价"之举。15年前，"要么接受、要么放弃"的做法令希拉里的医改方案遭致失败，但本届政府却立志于要将改革方案变成真正的法律。共和党人明白，奥巴马可以将参议院此前提出的议案变成法律，只要他向众议院民主党人承诺在"调解"阶段对方案进行修改，而后者只需参议院简单多数通过。奥巴马的新提案就包含了一些妥协，包括向承担补助医疗保险(Medicaid)成本的各州政府提供补助――此举已经赢取了一位内布拉斯加州参议员的投票；还包括暂时减缓"豪华保单税"的冲击，扩大原本只面向工会成员的政策适用范围。
提案中唯一的新点子是一项有争议的内容，即成立一家负责控制保费的机构。奥巴马抓住保险公司Wellpoint上周计划将加州部分客户的保费提高39%的机会，抛出了这一计策。共和党人如果反对这项平民主义提议，将是危险的。但奥巴马的愤怒并非发自内心。正如该保险公司在致奥巴马政府的信函中所解释的那样，它必须覆盖加州日益缺乏吸引力的风险池。现行法规几乎未采取任何措施来消除这种保险精算异常，也忽视了导致医疗成本如此高昂的多数因素。
但即将到来的斗争是政治上的，而不是经济上的。奥巴马地位稳固，但不再足以把他的医改方案外包给国会中的同盟者。他现在正在押下赌注，要让他亮出底牌，共和党人必须万分小心。
Lex专栏是由FT评论家联合撰写的短评，对全球经济与商业进行精辟分析
译者/杨远
Until the Democrats' stunning electoral setback in Massachusetts, Barack Obama held what seemed an unbeatable hand in his healthcare poker game. Having put too many political chips on the table to be ready to fold, he is instead going all-in ahead of Thursday's televised healthcare summit.
Taking the reins, Mr Obama yesterday laid out what a spokesman called an "opening bid" to craft a deal. A take-it-or-leave-it approach sank Hillarycare 15 years ago, but this administration has actual legislation to work with. Republicans know Mr Obama could make the existing Senate bill law by promising House Democrats to amend it later in "reconciliation" only requiring a simple Senate majority. Mr Obama's proposal represents this compromise, giving every state the subsidy on Medicaid costs used to win one Nebraska senator's vote, and temporarily softening the blow from the excise tax on pricey healthcare schemes, extending a deal previously offered only to union members.
The only new element to the plan, and a controversial one, is creating a body to control insurance premiums. The president seized on a proposed 39 per cent increase for some of insurer Wellpoint's California customers last week to introduce this angle. It will be dangerous for Republicans to oppose the populist proposal, but Mr Obama's outrage is disingenuous. As the insurer has explained in a letter to the Obama administration, it has to cover an ever less attractive risk pool in California. Existing law does too little to eliminate this actuarial anomaly, and ignores most factors that make healthcare costs so high.
But the looming battle concerns politics, not economics. Mr Obama's position is strong, though no longer strong enough to outsource Obamacare to congressional allies. He is placing the bets now and Republicans must be very careful about calling his bluff.
http://www.ftchinese.com/story/001031410
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